One brief message at a time, Lancet editor Richard Horton is tweeting his dark view of the contemporary medical establishment. If you have any interest at all in peeking behind the curtain to see what really goes on behind the scenes of top medical organizations then you need to follow Richard Horton's Twitter feed. In sudden bursts of candor, humor, and cynicism, Horton has been tweeting thoughts that don't often see the light of day.

Here's his unvarnished opinion of the World Health Organization, for instance:

WHO is no longer a science-based organisation. WHO believes that scientists within the agency should be anonymous bureaucrats.

Science in WHO is seen as a dangerously subversive activity. Publication in journals brings the threat of disciplinary

And here's a glimpse of the British side of the medical elite that we don't normally see:

England is run by strange clubs. The Athenaeum is the one for high-ranking doctors. You can feel death oozing from the wood panels.

If you enter, you find cabals of Presidents/Professors plotting/sleeping in corners: an up-market rest home for the medical establishment.

And here's the thread of tweets that prompted this post. It started a few weeks ago, and it's about an ongoing editorial battle with authors and another highly respected journal. I can't remember these sort of statements ever being made in public before, though these sort of stories are often discussed privately and always, to a journalist, off the record. The significance of these remarks is considerable. As Horton remarks at the end, the episode appears to lend evidence to the manipulation of journals by industry. (I've placed the tweets in chronological order to make them easier to read.)

When papers get salami sliced and divided between NEJM and us, it gets complicated. And sometimes nasty. And today, even threatening.

Now put to rest a terrible authorship dispute that has blocked an accepted paper for months. Crucial lesson: agree authors before starting.

The mother of all authorship disputes has broken out.

When papers get salami sliced and divided between NEJM and us, it gets complicated. And sometimes nasty. And today, even threatening.

In the saga of our salami sliced paper at NEJM and Lancet, both journals are now saying, it's us or no go. This is getting silly.

NEJM/Lancet salami story, Part 164: US author writes to report "significant disagreement" among authors. We are told to suspend review...

Authors on both versions of what seems to be largely the same paper with our two journals to gather and resolve their dispute. We wait...

Lancet/NEJM salami latest. From Principal Investigator. "Approval [of the drug in question] has already occurred in the US, yet...

...private insurers are slow to place it on their formulary. A major publication is typically how this occurs in the US, and it is...

important to be in a journal typically recognised by US-based companies. This would include NEJM...Therefore, this publication is critical..

...to [company A's] ability to "market" their product. Lancet, on the other hand, will aid [company Y] quite nicely."

I cover cardiology news for CardioExchange, a social media website for cardiologists published by the New England Journal of Medicine. I was the editor of TheHeart.Org from its inception in 1999 until December 2008. Following the purchase of TheHeart.Org by WebMD in 2005, I ...